Cerebro-meningeal infections in HIV-infected patients: a study of 116 cases in Libreville, Gabon.

Background: Cerebro-meningeal pathology is common in human immunodeficiency virus (HIV) infection and the aetiology is often difficult to ascertain with certainty. Objective: To describe the major suspected and identified causes of meningeal or encephalitic syndromes in HIV infection in Libreville, Gabon. Methods: A descriptive study using clinical records of patients hospitalised in the Department of Medicine in the Military Hospital of Libreville (Gabon) between January 2006 and May 2010. Clinical features were evaluated using multivariable logistic regression to evaluate association with the outcome of a clinical improvement or death. Results: The most frequent neurological symptoms were reduced level of consciousness (54.3%), headache (55.2%), motor deficit (38.7%), and convulsions (36.2%). Cerebral toxoplasmosis represented 64.7% of diagnoses, followed by cryptococcal neuromeningitis in 12.9% of cases. Tuberculoma was diagnosed in 4 cases and lymphoma in 2 cases. In 9.5% of cases, no aetiology was determined. Toxoplasmosis treatment led to clinical improvement in 69.3% of cases with suspected cerebral toxoplasmosis. Overall mortality was 39.7%. Conclusion: The diagnosis of neurological conditions in HIV positive patients is difficult, particularly in a low-resource setting. A trial of treatment for toxoplasmosis should be initiated first line with all signs of neurological pathology in a patient infected with HIV

Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru.

The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26-52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis

Memory writing and postcolonial discourse in historical contemporary novel : comparative approach of algerian, congolese and haitian literatures

La mémoire occupe une place importante, tant dans les sociétés en générale que dans la littérature en particulier où elle est devenue une référence obligée, une exigence éthique et poétique pour comprendre le passé. Depuis quelques décennies déjà les questions liées à la mémoire reviennent de plus en plus sur la scène littéraire et politique. Dans cette optique, la présente thèse tente de réfléchir sur l’écriture de la mémoire envisagée dans une perspective postcoloniale à travers le roman historique contemporain. Le titre et le débat qu’il soulève mettent en relation les littératures algérienne, congolaise et haïtienne dans le but d’analyser la représentation du passé dans quatre romans : La Femme sans sépulture de Assia Djebar, Le Lys et le Flamboyant de Henri Lopes, Rosalie l’Infâme de Évelyne Trouillot et Ombres dansantes ou le zombie, c’est moi de Hans Christoph Buch. L’omniprésence de la thématique de la mémoire dans ces romans et l’enchevêtrement des faits de l’Histoire et des destins particuliers des personnages invitent à une approche comparatiste. Cette approche est adoptée ici en tant qu’elle nourrit un regard réflexif sur les pratiques culturelles des sociétés algérienne, congolaise et haïtienne. Cette étude a le dessein de poser d’abord, les fondements théoriques des notions et concepts de mémoire, de postcolonialisme en procédant à leur exégèse. Ensuite, elle examine la représentation du passé dans les espaces culturels africain et caribéen à travers les oeuvres sélectionnées. Et enfin, elle construit une poétique de la mémoire postcoloniale dans le roman historique contemporain. Sur fond d’une réécriture de l’Histoire, se dessine ici les contours d’un ensemble de pratiques auctoriales qui s’inscrivent dans une revisitation permanente des récits de l'historiographie.The Memory has an important place, in our societies in general as well in literature, particularly where it became an unavoidable reference, an ethical and poetic requirement to have a better understanding of our past. For decades yet the questions related to our memory increasingly come back on the political and literary scene. This thesis intends to reflect on the writing of Memory considered in a postcolonial perspective through the historical contemporary novel. The title and thedebate raised put in relation the Algerian, Congolese and Haitian literature in the aim to analyse the representation of the past with the following novels The Woman without sepulcher from Assia Djebar, The Lily and Flamboyant from Henri Lopes, The Infamous Rosalie from Évelyne Trouillot and Dancing shadows or zombi, it’s me from Hans Christoph Buch. The omnipresence of the theme of memory in these four novels and the entanglement of the facts of the History and the particular draws of the characters presented invite to a comparative approach. This approach is adopted here so it canfeed a reflexive look on the cultural practices of the Algerian, Congolese and Haitian societies. This study has the goal to first display the theoretical foundations of Memory notions and concepts, from postcolonialism proceeding to their exegesis. Then, it examines the representation of the past in the African and Caribbean culturals spaces through their selected artwork. Finally, it builds a poetic of the postcolonial memory in the historical contemporary novel. Painted like a rewriting of the History, appear here the outlines of a whole series of auctorial practices entering in a permanent new twist of the Historiography texts

Limited access to drugs for resistant tuberculosis: a call to action

Although the rate of new tuberculosis (TB) cases has been falling worldwide, progress toward the targets for diagnosis and treatment of drug-resistant TB is far off-track. In countries with no reliable TB surveillance system, setbacks and progression of TB control is barely reflected and little is known on the situation in the field. Interviews with health professionals in Gabon revealed limited access to first- and second-line TB drugs and important deficiencies in basic TB control. National and international action needs to be taken to meet the global TB control target

Klebsiella Pneumoniae Communiy-Acquired Pneumonia in a Trisomic at Omar Bongo Ondimba's Army Instruction Hospital (HIA OBO)

Kp community-acquired pneumonia is rarely encountered. Its prevalence is higher in Asia, where a higher strain virulence was demonstrated [1,2]. It’s a pyo-pneumothorax, which usually occurs on debilitated or&nbsp; immuno-compromised patients. It is a severe disease&nbsp;associated with high mortality. Here, we report the observation of a Kp community-acquired pneumonia occurring in a genetic disorder context.</p